This rigorously sourced paper illustrates the absurdity and futility of the crackdown on prescribed pain medication.

Dr. Kertesz meticulously lays out the facts (backed by 50 references to scientific research) proving that opioid prescriptions to patients are not the primary driver of the increasing numbers of overdose deaths.

Restricting such prescriptions has only caused a crisis of untreated pain while doing absolutely nothing to treat the addiction and abuse at the root of most overdoses.

I have tracked down some of the “research” behind the so-called CDC practice guidelines published in March 2016. And the research is an absolute CROCK! Particularly astounding is the biased and unscientific […]

These arguments against the CDC’s guidelines are specific, logically argued, and carefully thought out, explaining some aspects that seemed muddled, but are clear to a practicing doctor. The Centers for Disease Control report that 2014 saw a record of 18,893 deaths related to opioid […]

This is a 6-page article, with some thoughtful criticism of the guidelines, addressing some of their striking shortcomings. The initial draft guidelines were met with sharp criticism from a number of medical organizations, including the American Academy of Pain Medicine (AAPM), American Medical Association […]

The Issues With the CDC Guidelines on Opioids for Chronic Pain, According to AAPM’s Director by Florence Chaverneff, Ph.D. September 26, 2016

This article is noteworthy because of where it appears (in a publication mostly dedicated to parroting the CDC’s ideas) and who is speaking (BobTwillman, president of the American Association of Pain Management) In […]

Recently, we (along with our colleague, Dr. Jacqueline Pratt Cleary) published an open access article in the Journal of Pain Research, entitled “The MEDD Myth: The Impact of Pseudoscience on Pain Research […]

In a move that may have more to do with politics than healthcare, the U.S. Food and Drug Administration has set aside the advice of its own experts by endorsing the CDC’s controversial guidelines for opioid prescribing The move is part […]

In my former life prior to chronic pain and illness I had many important and fascinating jobs. One was as a peer reviewer for the United States National Institutes for Health (NIH), Center for Mental […]

New CDC Opioid Guidelines: The Good, the Bad, and the Ugly – Charles E. Argoff, MD – May 13, 2016

In this article, Dr. Argoff picks apart the guideline and explains which parts are relatively sound, and which are spurious. The guideline’s purpose is to: “improve communication between clinicians and patients about the risks and […]

Responses and Criticisms Over New CDC Opioid Prescribing Guidelines | March 18, 2016

In their statements, both the American Academy of Pain Medicine (AAPM) and the American Medical Association (AMA) first cautiously express approval of the CDC’s intentions (obviously intimidated) before diving into the glaring problems with the guidelines. I feel the worst part is the fixed […]

Recent guidelines handed down from the Centers for Disease Control and Prevention (CDC) concerning the prescription of opioids have made waves among healthcare professionals. The CDC condemned the practice of prescribing these drugs in the vast majority of cases. Furthermore, these guidelines […]

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16 thoughts on “Evidence Against CDC Opioid Guidelines”

Zyp, you’ve done a major service in the collection of these references. I will incorporate them into a letter which I am circulating to the Healthcare Legislative Assistants for several US Senators, lobbying for the Senate to take effective action to force the CDC to withdraw and rewrite the Opioid guidelines. Clearly in their present form these defacto restrictive standards are causing grievous harm to hundreds of thousands of chronic pain patients and thousands of doctors. Please be sure that this posting remains on your blog, and is periodically broadcast and reannounced to patients and legislators.

I am a chronic intractable pain patient that has debilitating incurable diseases that cause severe pain every day. I have been greatly affected by this so called opiod epidemic, my QUALITY OF LIFE taken. Ten long years of all kinds of alternative therapies, injections, epidurals, steriods, failed surgeries, water therapy, massage, chiro, accupuncture, discectomies, nerves burned, all kinds of meds, opiods the last resort, like it is for nearly all chronic intractable pain patients, unlike what the government is preaching to the public. I was on the same stable dose for six years with success, never painfree, the pain was tolerable. I was able to cook for my kid, food shop, go to my sons games, be in a car more then ten mins, shower daily, sleep, and more. My dr of five years lowered my meds over a year ago to ineffective doses and took some away. Recently he’s been mentioning me going to detox. I am NOT an addict Opiods allowed me some semblance of a QUALITY OF LIFE! Chornic pain pts do NOT get high off their meds, they get pain relief! Every day I read about another pain pt who took thier life due to inadequate pain relief.Pain pts are being firced to exist in a torturous hell! Thank you for exposing the truth!

Here’s a sample letter. It’s very long so you may just want to copy part of it.

Edited from input sent February 7, 2017 to AdvanceNotice2018@cms.hhs.gov
To whom it may concern,
I write to strongly oppose the proposed alignment of practice standards at the US Centers for Medicare and Medicaid Services, with the Centers for Disease Control and Prevention March 2016 guidelines on prescription of opioids to adult non-cancer chronic pain patients.
On multiple grounds, the CDC guideline is an ongoing disaster for both pain patients and medical professionals. The guidelines must be immediately withdrawn and rewritten by an unbiased body of consultants including as key members, board certified specialists who are active in the community practice of pain management, as well as chronic pain patients themselves.
– The CDC Guidelines are already having an enormous negative impact on the lives of tens (possibly hundreds) of thousands among the 100 Million+ chronic pain patients in America.
— Doctors – both general practitioners and specialists – are leaving pain management practice in droves, fearing malicious and arbitrary prosecution by DEA for “over-prescription” of opioids — against a standard of prescription which is ill-supported by the medical evidence.
— Patients who have long been successfully managed on high doses of opioids are being outright deserted, in many cases without withdrawal assistance or oversight, and uniformly without access to effective alternative means for maintaining the quality and functionality of their lives.
— Many among those deserted are lapsing into disability, losing their ability to sustain former employment or family relationships that have benefited from treatment of pain with opioids.
— Some patients have already committed suicide, overcome by agony imposed on them by their physicians. More are likely to suicide as this crisis continues and deepens.
– Even in its own published content, the CDC Guidelines acknowledge that recommendations are grounded upon very weak medical evidence.
— Conclusions were drawn which substantially exceeded the content or clarity of the available medical evidence.
— Conclusions were drawn which contradicted or omitted previous research published in FDA and NIH studies. Particularly damning are published CDC workshop findings that confirm the existence of a substantial cohort of patients among whom opioid treatment is both appropriate and an only resort after the failure of all other therapies.
— Extended commentary submitted on the draft Guidelines by the American Academy of Pain Management appears to have been largely ignored — with neither explanation nor rationale.
— It appears that public health statistics were misinterpreted and may have been deliberately distorted to support a largely fictitious “epidemic” of deaths mis-attributed to opioids prescribed to pain patients.
— Although opioid-related deaths are a serious public health issue, they are for the most part not being caused by drugs prescribed to legitimate pain patients. Research published by the CDC itself reveals that death statistics are dominated by illegally imported Fentanil, Heroin, Methadone, and opioids diverted by theft or fraud to the street.
– There is now incontrovertible proof that the CDC Consultants Working Group which wrote the Guidelines deliberately biased their consideration of medical research to unfairly disadvantage and discount the effectiveness of opioids in treating chronic pain. They also substantially inflated the perceived risks of opioid prescription by ignoring multiple confounding factors in the studies used to support their Guidelines.
– There is credible evidence that key figures associated with the CDC attempted to write Guidelines which would divert research and treatment funds to professionals in addiction psychiatry, to the disadvantage of professionals in chronic pain. The guidelines process up to December 2015 was dominated by participants who had vested financial and professional interests in this diversion of resources. That process was also largely closed to the public until challenged by Congressional overseers.
– Especially disqualifying is the fact that the CDC Guideline fails to acknowledge a number of key facts widely accepted in the practice of pain management.
— Nowhere in the Guideline are genetic factors acknowledged which create wide variability in opioid metabolism and drug tolerance among the patient population. This variation directly contradicts most of the dose limit rationale embedded in the Guideline.
— Nowhere in the Guideline are controversies acknowledged with pertain to Morphine Milligram Equivalent Dose determination. Estimated MMED is considered by many practitioners to be a to be a matter of mythology and opinion, not science.
— The Guideline appears to parrot an unproven assertion that drug tolerance and “hyperesthesia” are universally experienced among chronic pain patients — which is deeply contradicted by some published studies and by widespread reports of patients themselves. Hyperesthesia appears to be relatively rare among chronic pain patients, though no reliable statistics are available on its incidence.
– The CDC Guidelines were originally phrased as advisory for general practitioners and subject to tailoring for each individual patient — not mandatory for all physicians or applied as a one-size-fits-all restrictive edict. If made mandatory, the 90 MMED upper limit on opioid dose levels will effectively destroy the lives of many tens of thousands of chronic pain patients who have been maintained at stable doses above 100 MMED (often above 400 MMED) for years.
The CMS system MUST NOT accept the CDC Opioid Guidelines as a basis for mandatory practice standards. These Guidelines are scientifically invalid, biased by professional self-interest among addiction treatment specialists, and highly destructive in their effects on chronic pain patients. As support for this position, I encourage you to read some of the many references cataloged here: https://edsinfo.wordpress.com/2017/02/01/evidence-against-cdc-opioid-guidelines/ “Evidence Against CDC Opioid Guidelines”.

how do we get more doctors and reps to look into this and be fair with pain suffers who are not addicted but need pain meds to live a near normal life..this also effects the old..who have to go into assisted living and live like a veggie when one or two pills keep them independent…this is not fair…what will it take to stop this punishing the people that need pain relief..because of some government stupid rules….

Patients and families need to SUE THE B*STARDS for denial of care and patient abuse… and win. But first we need to find a legal firm that will tackle a large medical practice group, hospital, or insurance company, and spent five to ten years battering them into submission in court. That’s what it took with Big Tobacco. I doubt that we’ll do any better with the opioid deniers.

Yes, I’m getting more and more angry – especially now that a doc tapered my mom from 15MME to 10MME. Why?!?

Now she can barely walk anymore and can’t go to her exercise classes. The pain she had struggled to control with 3 Vicodin/day is too overwhelming and she has given up. Now she spends most of her time in bed, losing muscle tone and getting depressed to the point she’s just waiting to die. This was a healthy, active, independent 88-yr-old woman, and now she’s bed-bound.

What does this accomplish? Why torture this old lady in the last few years of her life? Why is no one accountable for her misery?

I thought my worst problem would be my own increasing pain, but now that these rules are torturing my helpless old mother, I’m getting furious.

I love you lol. I too have already -as of last month-old had my meds reduced 10% did to fear and pressure on my doc. He is considering closing his pain management office. We are in a rural area. I have Transverse Mylitis. Horrible pain is the second symptom after paralysis. Yep, a Para now. Nothing but my bedroom… and this f**king psin.
You all know what we think of, too often.
Letter writing time!!

Holy cow! Major spelling fail heh. Haven’t slept. It’s Fentynal patch day. Have about a 6 hour ago in pain coverage. The 10% of pain meds decreased by my frightened pain doc.
Thank you again for the wonderful collection of articles to help back up and highlight the grave plight of pain patients.

I have wrote every senator and congressmen in Oregon, only to have responded that were form letters quoting the CDC. I most likely read the guideline before they even did. You see my sister in-law was the assistant to the neurosurgeon that’s wrote the guideline. I was not written by a unbiased group of doctors but The National Patient Safety Foundation. My sister in-law had no prior medical knowledge- though she does have several degrees but in political science and journalism. I myself, have many severe chronic pain conditions and has had my meds cut to an ineffective amount. I’m a gastric bipass patient as well, the guideline do not make adjustments for those of us that can’t absorb all of the medication before it leaves our system. Percocet will stay in most patients approximately 6 hours, mine leaves my system in about 3 1\2 hours, so for th next couple of hours I am bed bound.( I’m 53yrs old) in nursing I was always told not to let a pain patients meds wear out because it to hard to get the pain under control if you wait to long. Up until the beginning of this year I was on liquid oxycodone because of its better for bipass patients and a working dose. I went swimming 2x a week, walked on the beach every other day and played with my granddaughter everyday, now I’m a shell of my former self. How do we stop this insanity, I’m at a loss.

The ATIP group is urging people to actually speak to legislators, not just write them. I’ll be blogging an article soon about experiments showing that a voice is much more persuasive than anything written, so that IS something you can do.

Imagine a legislator reading your letter versus having to listen to you in your agony on the phone!

The ATIP group has provided instructions and reference materials exactly for this purpose.

As I’m sure you know too, this is a matter of life & death for us pain patients.

Laura, I want to speak at length with your Sister about what she knows concerning the members of the writing group and the process they used to come up with the CDC guidelines. Please pass my email address: lawhern@hotmail.com

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